Monthly Archives: April 2016

There was a pharmacy owner in the news recently for filling fraudulent prescriptions. He was caught as a direct result of PDMP. Let’s take a look at this case and the program itself.

The primary purpose of the PDMP is to improve patient care and safety and reduce the abuse and diversion of prescription drugs in Wisconsin while ensuring patients with a legitimate medical need for the drugs are not adversely affected.

The New Berlin HealthMart Pharmacy remains closed after a search warrant was executed in late March. According to the search warrant, the owner of the pharmacy illegally supplied friends and family members with painkillers and filled bogus prescriptions. The owner is also accused of selling 500-count bottles of hydrocodone for $1,000 each and giving medication to the co-owner of a strip club where he allegedly drinks for free.

Investigators reviewed the PDMP records for controlled substance prescriptions dispensed from New Berlin HealthMart Pharmacy from January 1, 2014 through April 28, 2015.

According to the search warrant, the pharmacy’s owner filled prescriptions using the names of real doctors who in most cases, had never heard of the patient. In two cases, the patient and doctor names were real, but the doctor stated he/she did not prescribe that individual the medication that was dispensed at The New Berlin Pharmacy.

In 2013, Wisconsin launched a statewide prescription drug monitoring program, known as the PDMP. Similar databases exist in 49 states and require all prescribing physicians and pharmacies to enter controlled substances into the system. “The origins of prescription drug monitoring programs are a result of the nationwide prescription drug abuse epidemic,” PDMP Director Chad Zadrazil said. “Information inputted into the system includes data about the patient, information about the drug and prescriber, and information about the dispenser or pharmacy.”

Investigators reviewed the PDMP records for controlled substance prescriptions dispensed from the New Berlin HealthMart Pharmacy from January 1, 2014 through April 28, 2015 and found discrepancies.

Background on the PDMP:

Police and federal agents can request data at any time from the PDMP, but it’s meant to be a research tool for doctors and pharmacists who want to see what a previous patient has been prescribed. Current policy requires doctors and pharmacies to enter patient information into the system within 7 days. Next year, new regulations will require that information be inputted the next business day.

While the PDMP system is meant to crack down on “doctor shoppers,” the system did help investigators in looking into “suspicious” prescriptions filled at New Berlin HealthMart Pharmacy.

“We do quarterly audits for pharmacy compliance to make sure they are submitting data that meets our requirements in a timely manner,” Zadrazil said.

The PDMP is overseen by the Department of Safety and Professional Services.

Local and federal authorities said they believed the target of the probe allegedly had written more than 500 fraudulent prescriptions. New Berlin and DEA investigators said they had already found indications that the pharmacy owner may have filled fraudulent prescriptions for family and friends and then billed insurance companies, according to the affidavit. Investigators said they had reviewed prescriptions from 11 doctors. All of the doctors denied ever writing the prescriptions.

In addition, insurance companies had paid the pharmacy for at least some of those prescriptions, investigators said in the search warrant. The warrant noted that in one case the amount Wisconsin paid in 2015 through its Forward Health program on the allegedly fraudulent prescriptions for four people topped $61,000. Those four included the pharmacy owner’s wife, the affidavit noted.

Catching this pharmacy owner is important. I am not sure why it had to take so long, but since I am not an investigator I can’t speak to that. I hope they work to stop such incidents sooner.

All ‘dispensers’ are required to submit every prescription whether that be a single pill, a starter pack or a larger prescription. Dispensers are those who dispense the drugs to the patients. Dispensers can be pharmacists, hospitals or clinics, including emergency rooms. This does not include the person administering the drug to the patient. It includes the person or persons that receive the drug from the manufacturer and dispense them for patient use.

It does not include the person who writes the prescription. The dispenser includes that information when they make their submission. Maybe if prescribers themselves also had to submit each of their prescriptions to this database it may slow some of the prescribing. If it wasn’t so easy to just send a patient on their way with the drug they crave it may change those habits. And I believe that is what it is, a habit. It is easier to write the prescription than to help the patient find better ways of managing their pain. It is easier than dealing with the insistent drug abuser who calls incessantly seeking yet another prescription.

What I would like to know is, do those at the PDMP review prescribers for the amount of prescriptions they write? Part of the problem these days is that there are so many prescribers that give out controlled substance prescriptions like candy. Many without thought to where those dangerous drugs end up.

Recently, law enforcement has been added to those required to add to this database. Wisconsin Act 268, which became effective on March 18, 2016, requires law enforcement agencies to submit information to the PDMP in four specific situations. The situations described in the law are:

When a law enforcement officer reasonably suspects that a violation of the Controlled Substances Act involving a prescribed drug is occurring or has occurred.

When a law enforcement officer believes someone is undergoing or has immediately prior experienced an opioid-related drug overdose.

When a law enforcement officer believes someone died as a result of using a narcotic drug.

When a law enforcement officer receives a report of a stolen controlled substance prescription.

When any of the situations occur, the law enforcement agency is required to submit to the PDMP the applicable data from the list below:

The name and date of birth of the individual who is suspected of violating the Controlled Substances Act.

The name and date of birth of the individual who experienced an opioid-related drug overdose.

The name and date of birth of the individual who died as a result of using a narcotic drug.

The name and date of birth of the individual who filed the report of a stolen controlled-substance prescription.

The name and date of birth of the individual for whom the prescription drug involved in the suspected violation, drug overdose, or death was prescribed.

If a prescription medicine container or prescription order was in the vicinity of the suspected violation, drug overdose, or death or if a controlled-substance prescription was reported stolen, the following:

The name of the prescriber

The prescription number

The name of the drug as it appears on the prescription order or prescription medicine container

I think this is a great addition to the PDMP. Sometimes those on the front lines are our best advocates for reform. They see the direct result of our over-prescribing. I think such prescriptions should be flagged as critical for review. If there are ‘repeat offenders’, or prescribers whose patients overdose or die in multiple incidents, they should be stopped.

I don’t mean to blame others for the addict’s drug use. It is, of course, not the prescriber who puts the drugs into the addict. But often times, as in my case, addiction begins with prescription drugs taken for legitimate reasons. The problem comes later when the drugs are used after the legitimate need ends. The drugs continue to be prescribed even though the issue requiring their use has ended. Patients can be manipulative and prescribers can be easily swayed. We need to change the culture of prescribing narcotics for all kinds of pain. Prescribers need to learn the word ‘no’. They need to suggest milder remedies that may just work if given a chance. Too often, patients don’t even try, and prescribers don’t suggest alternatives to narcotics. This should be the first treatment option.

Last month I heard about a young nurse, age 23, who died of a heroin overdose. Jessica Ludwiczak was dropped off at an ER in a comatose state by an unknown man. There were track marks on her body. Her family was stunned, they had no idea she used drugs. She was a nurse at a local hospital, she was studying at Alverno College to become a registered nurse. Her family said there were no signs that indicated Ms. Ludwiczak had a drug problem…no signs. That is the key point in this story to me. Nobody knew I was using either. We, addicts, can be so good at hiding our drug use. This is why we need to be randomly drug tested. Maybe if they had this requirement at the hospital where Ms. Ludwiczak worked they would have caught her. Sure, it would have been devastating to this young nurse. Her career dreams would have been seriously altered. But she would have been alive. She would have had the opportunity to start her life, her career over again. She may have been successful at fighting her addiction, she may not have been, but she would have had a chance. She has no chance now. It is such a waste of a life, what could have been a beautiful life.

I used drugs for years and nobody knew…NOBODY. I was smart, or so I thought. I knew how much I could take while working so that nobody would suspect. Please note that I write ‘while working’. I did not just do this in the privacy of my home while my children were safely tucked in bed. No, I did it whenever I could. While working, while driving, while taking care of my kids, while visiting friends and family, anytime I had drugs to take. As my addiction progressed I became less able to control when and where I used them.

Yet, I was one of the lucky ones, although it didn’t feel that way at the time. I got caught before having to suffer Ms. Ludwiczak’s fate. Nobody suspected I was using until the stock supply started disappearing. You see, after a time I could no longer wait for the ‘waste’ drugs, I craved them so badly. Once I started taking the stock supply it didn’t take them long to figure out it was me. I was arrested and charged with 26 felonies. I was absolutely devastated. I had no idea what I was going to do. But again I say, I was one of the lucky ones, I ended up getting clean (after a few more stumbles) and have stayed that way for 11 years (and counting). I am a nurse in good standing again.

I think the most important thing to take away from this blog is that you can’t always tell if someone is using drugs or not using drugs. If you depend on being able to identify those with a substance abuse problem by sight you will be missing many of them. Sure there are some that reek of alcohol, pass out in bathrooms or get arrested, those are the obvious cases, but there are just as many that are hiding an addiction that nobody can see. They are the ones that we need to focus our attention on. They are the ones that may be helped if random urine drug screens would be required of all healthcare workers with access to controlled substances. Detecting their problem could prevent a death. The death of the addict or their patient’s death. They are dangerous, I was dangerous. I didn’t think so at the time, I thought I had it all figured out. But I was fooling myself. Anyone who is high at work is risking their patient’s safety. Their decisions and reactions are flawed.

Please join me in my quest to get people to listen. The public needs to understand the scope of the problem. The Licensing Boards need to advocate for random drug testing. The government needs to require it. I am one voice and few are listening to me. I need more voices.